Selective Mutism: Causes, Symptoms, and Treatment

Satchit Ghimire- Selective mutism is a childhood anxiety disorder characterized by an inability to speak in certain situations such as school and other social settings. This disorder starts during childhood and can persist longer if left untreated.

Photo by Kristina Flour on Unsplash

Children with this disorder are unable to speak in school but can talk and communicate with ease in settings where they are comfortable and relaxed. The children with selective mutism have the physical and cognitive ability to speak. They also want and try to speak, but they have a persistent inability to speak due to anxiety.

Selective mutism affects about 1 out of 140 young children, and more than 90% of children with Selective Mutism also have a social anxiety disorder.

Causes of Selective Mutism

The causes of selective mutism are yet to be fully understood. Research shows that there are many factors like anxiety, poor family relationships, low self-esteem, speech/ language difficulties, etc., that might lead to selective mutism.

Many people wrongly believe that selective mutism is linked with autism, but this is not true.

Symptoms of Selective Mutism

  • Ability to speak in certain settings like home but the inability to speak in particular settings when other people are around.
  • Fearful or anxious or even angry when asked questions by strangers.
  • Communicating by gestures like pointing, nodding, uttering sounds or one-syllable words despite knowing how to talk.

Diagnosis of Selective Mutism

There is no specific test for selective mutism. The diagnosis is made by a qualified professional based on the symptoms. The health professional will also look to rule out other medical conditions. As children or adolescents with this disorder have difficulty participating in interviews, the expert will rely on the information provided by parents, teachers, and other adults in the child’s life.

Sometimes the healthcare provider might observe the child at home or school. S/he may ask you to record videos of your child at home or school.


The treatment for selective mutism might include:

Shaping: Shaping refers to a structured approach to reinforce a person in an attempt to produce the desired behavior. It includes gestures, mouthing, or whispering that will eventually lead to audible speech.

Systematic desensitization: It involves gradually exposing the children to increasingly difficult speaking tasks under the supervision of qualified professionals.

Speech Therapy: Speech therapy can be done if there are any speech-related problems.

Cognitive behavior therapy: This helps to deal with emotional issues, fear, and anxiety.

Stimulus fading: In stimulus fading, the child having selective mutism communicates with someone familiar to them, like their parent, at ease. Then another person is brought into the room, and once they are included in the verbal conversation, the parent withdraws.

Medications: Medications may also be appropriate in severe or chronic cases when other methods didn’t work.

Professionals often use selective serotonin reuptake inhibitors (SSRIs), also known as antidepressants, to treat selective mutism.

References and Further Reading

  1. NHS website. (2021, February 26). Selective mutism. Nhs.Uk.

2. NORD – National Organization for Rare Disorders. (2016, November 11). Mutism, Selective.

3. Selective mutism. Anxiety Canada.

4. Pietro, S. (2021, January 28). Selective Mutism (SM) Basics. Child Mind Institute.

5. Selective Mutism. Cedars-Sinai.—pediatrics/s/selective-mutism.html

6. Selective Mutism. Spectrum Speech.

7. Understanding Symptoms, Diagnosis and Treatment of Selective Mutism. (2020, September). Verywell Mind.